In previous issues of this newspaper, we have often commented on the state of the National Health Service and on those who leach off it – managers, private healthcare peddlers, the drug giants, building firms, the plethora of dodgy politicians from all bourgeois parties and so on. We have also looked at the plight of the patients who use it, and of those working within it, as well as at their attempts to fight back, such as the junior doctors’ strike last year.

The more the capitalist crisis deepens, the more the attacks on the NHS are intensifying. With ever-increasing financial constraints, cutbacks, healthcare rationing, stealth charging, outsourcing and all manner of privatisations by the back and side doors, we can increasingly say our battle cry should no longer be ‘save the NHS’ but rather ‘rebuild an NHS!’

We desperately need a health service that is completely publicly owned and run, including dentistry, optometry, all drug production and every single hospital and clinic. We need an NHS where no private interest can make any profit, all staff involved in the system, from surgeons to cleaners and cooks, are employed by the NHS, all pay structures are negotiated at a national level; and where all prescriptions and treatments are free.

Such provision for people’s primary needs are fundamental to a civilised society, and is a reality in socialist countries like Cuba, despite it being a relatively poor country still subject to an imperialist blockade.

Where and how will we get such an NHS? As the Soviet Union in the past and Cuba today show, it can only truly be achieved when capitalism itself is thrown into the dustbin of history, and it is only when workers seriously engage in that struggle that we will see sustained change for the better.

Nurses on the healthcare frontline

Nurses have always been held in very high regard by most working-class people, who recognise the commitment and devotion of these heroes in our midst. Nearly all of us know from our personal experience, or that of our close family members, that the overwhelming majority of nurses work hard, care deeply and remain cheerful throughout, no matter the stresses and strains they are under.

But their work has moved on from hard to virtually impossible as the numbers of nursing staff in NHS hospitals is dropping to dangerously low levels. Erratic shift patterns are being devised to hide the staff shortages by the bloated layer of ‘hospital managers’, whose unreasonable and unsafe demands are increasingly driving Britain’s nurses to despair and exhaustion.

Meanwhile, the pay for this misery is decreasing in real terms, owing to the public sector pay freeze that Chancellor Phillip Hammond considers so generous, while more and more responsibilities are being piled on the shoulders of the diminishing band who remain.

The nursing profession’s care and devotion is being battered by sleep deprivation, the impossibility of being in three different places at once doing as many different chores, all of them ‘urgent’, and the soul-destroying effects of poverty, whereby these workers, regardless of their long, unsociable and taxing hours are too often left struggling to make ends meet, with many now forced to use food banks – out of necessity, not as a lifestyle choice as Prime Minister May affects to believe.

That most nurses can somehow manage to remain cheerful is indeed miraculous, but all too often it increasingly resembles the ‘gallows humour’ of those condemned, without the possibility of a reprieve, in the face of endless struggle, stress and a shortage of many of life’s necessities.

It is not only the deliberate understaffing that is causing massive problems on the wards – the very situation described above is leading many nurses to give up the unequal struggle and walk away from a job that they have spent so long training for.

It would be a matter for mirth if it were not so serious when we hear the ignorant declare that the problem with the NHS is the ‘treating of foreigners’. The truth is that without foreign staff at all levels the NHS couldn’t provide even the truncated service that it gives now.

It has been estimated that in the next three years the NHS will be spending £100m in an effort to find 5,000 new doctors. In other words, each doctor needed to plug growing staffing shortages will cost £20,000 in fees to ‘recruitment agencies’.

The current supply-demand gap is of a magnitude that speaks volumes about the gulf between ‘claimed’ government ambitions and reality. The reality is that poor working conditions for general practitioners and hospital doctors alike have become an impediment both to attracting and retaining recruits.

This has resulted in more British doctors emigrating to countries where there are better career and training opportunities along with greater remuneration and staffing levels, while the past decade of tougher immigration laws for non-EU migrants has drastically reduced the intake of foreign doctors to Britain.

The NHS depends on foreign recruits to operate in all levels of the health service. More than 30 percent of doctors in the NHS are foreign trained or born. Brexit will undoubtedly make this situation far worse. Polls show that some 60 percent of European doctors are thinking of leaving Britain. (See Guardian, 28 February 2017)

For a great many people the most noticeable sign of the imminent collapse of healthcare provision is when they or a loved one is admitted to hospital through A&E. Once through the sardine-like packing of people in the waiting rooms you get to the nurses’ stations surrounded by trolleys with the patients brought in by ambulances lying on them.

Amongst this group mill those who have rushed in with their ill relatives and the ambulance staff themselves, who cannot leave patients until they are signed in properly, meaning fewer ambulances out responding to emergency calls.

Another sign of NHS strain is the thousands of cancelled ‘minor’, but often vitally necessary, operations – anything from hip replacements to cataract removals, their high number caused by the shortages and cuts.

The British Medical Journal (BMJ) has found, following extensive investigation, that doctors seeking common treatments for their patients are increasingly forced into making individual funding requests to the local panels set up by health trusts to hear the pleas for discretionary financial approval for the necessary procedures.

In Buckinghamshire, in the period 2016-17, “doctors made 73,900 such requests, up 20 percent from the year before and 47 percent from 2013-14, when 50,200 were made, according to data gathered under Freedom of Information laws. About half the requests are granted, often after months of delay.” (See NHS Reality blog, 7 July 2017)

So where is the money going that bourgeois politicians brag about throwing at the NHS?

Besides paying over the odds to plug staffing shortfalls, huge amounts of NHS funding go to banks and other providers of loans in the form of interest and the inflated management costs of PFI contracts. In addition, there is the increasingly weighty layer of ‘managers’ squatting atop the NHS hierarchy, who are also being equipped with larger spoons for the salary banqueting table.

Managers in the NHS enjoyed pay rises three times greater than nurses according to official figures, which show that the average senior manager has seen basic pay rise 15 percent in cash terms since 2010 – seven years during which nurses have seen a 5 percent rise on average, far below the rise in the cost of living over that time.

A recent report analysing NHS pay reveals that there are presently 10,000 senior managers in the health service and each earns on average £77,578 – £9,926 more in cash terms than in August 2010. The average nurse now earns £31,089, up just £1,454 in the same period.

Janet Davies, the general secretary of the Royal College of Nursing, has said: “Despite ministers’ promises, pay for managers is spiralling upwards while nurses are handed year-on-year pay cuts. Morale is running low and news like this pushes it towards collapse.”

A spokesperson for ‘NHS Improvement’ defended the managers’ pay with the old claim: “The NHS needs strong and capable leaders to meet the challenges it faces.” Funny how bosses need large financial inducements to get the best from them but workers need threats and poverty to make them work.

As the crisis of overproduction continues to put a strain on the profits of some of the wealthy, while opening great opportunities to amass even greater fortunes to others of their number, working people need to decide what to do about it.

The NHS and the world we live in are both at the edge of destruction and both require our revolutionary action to pull them back. We can’t save the world by saving the NHS alone, but fighting to save the world by ending imperialism will be the start of building the health service we need.